Flap Prefabrication and Stem Cell–Assisted Tissue Expansion

Abstract

Total face skin and soft-tissue defects remain one of the biggest challenges in reconstructive surgery. Reconstruction of the entire face with uniform coverage and delicate features is difficult to achieve. To avoid the patchwork result seen in multiple flaps and skin grafts, 1 monoblock flap that has similar color, texture, and thickness might be an ideal option to minimize the incisional scars and several surgical procedures but is unavailable with current approaches because of the lack of sufficient matched tissue and the unreliable blood supply for such a large flap. To acquire a monoblock flap for full face reconstruction, we combine the prefabricated flaps, skin overexpansion, and bone marrow mononuclear stem cell transplantation for total facial resurfacing. In this article, we present our experience from our case series that provides universally matched skin and near-normal facial contour. It is a reliable and an excellent reconstructive option for massive facial skin defect.

Microdissected Prefabricated Flap: An Evolution in Flap Prefabrication

“…Experimental studies in rabbits and rats show that it occurs quickly, within 2 or 3 weeks, but in humans it takes at least 8 weeks [ 3 ]. In reported cases in the literature concerning large defects, the flaps were transferred 6 months after prefabrication [ 2 7 ]. This is a considerably long time.…”

“…In case of massive facial resurfacing, cervicothoracic skin is more appropriate as a donor site because of the color and texture match. An ideal vascular carrier should have large-caliber blood vessels with long pedicles for microvascular anastomosis, and it should not include any tissue other than a dense capillary network [ 2 ]. In the literature, muscle, fascia [ 3 4 5 6 7 ], omentum [ 8 ], and vessel bundles [ 9 10 11 ] have all been applied as the vascular carrier.…”

Total aesthetic subunit reconstruction of the burned anterior abdomen using pre‐expanded pedicled anterolateral thigh flap—A case report

“…The pre-expanded version of the pedicled ALT flap has only been described for urogenital reconstructions with a maximal surface area of 26 × 10 cm in an adult (Hocaoglu et al, 2014). Previous studies of pre-expanded perforator flaps yielded dimension as large as 21 × 11 cm in the pediatric population (Hocaoglu & Aydin, 2013) and 32 × 30 cm in the adult population (Li et al, 2014). This is the first report where a pre-expanded pedicled ALT is used for a burn case and for a nonurogenital area, in addition Previously, an easy and safe method for tissue expander placement to the ALT donor site was described by the senior author (Acarturk, 2014).…”

New approaches for full-thickness grafting of the face

“…Традиционное закрытие поврежденного участка кожи лица несколькими расщепленными трансплантатами приводит к формированию «плоского» лица с искусственным взглядом и ограниченным обзором, пересаженная кожа может иметь гофрированную «древесную текстуру» с неестественным цветом, с формированием рубцовой ткани, что становится показанием для проведения длительных реконструктивных операций [11]. Трансплантация полнослойного кожного аутографта лишена перечисленных недостатков, однако степень его приживления хуже, что обусловлено толщиной и площадью используемого лоскута, более длительным периодом восстановления кровообращения [12].…”

“…Обзор литературы показал единичные случаи применения клеточных технологий при кожной пластике лица. Например, Q. Li et al сообщают о результатах лечения пациентов при помощи мононуклеарных стволовых клеток костного мозга для закрытия раневой поверхности в комбинации со сборными расщепленными аутотрансплантатами [12]. Работы, изучающие приживление полнослойного кожного аутотрансплантата в комплексе с клеточными технологиями, особенно на лице, не проводились.…”